AB0641 An ultrasonographic study of the salivary glands in a cohort of patients affected by cryoglobulinemia vasculitis: preliminary results
Authors: A. Adinolfi, N. Ughi, D. A. Filippini, M. Chevallard, L. Belloli, C. Casu, M. Di Cicco, C. Gagliardi, M. C. Gerardi, M. Muscarà, E. Verduci, O. M. Epis
Journal: Annals of the Rheumatic Diseases (2022)

Background Xerostomia and xerophthalmia can occur in many diseases, rheumatological or not and are often reported by patients affected by cryoglobulinemia vasculitis 1 , particularly if related to the Hepatitis C virus infection (HCV) 2 . On the other hand, the Ultrasound (US) was extensively used for detecting pathological findings of the salivary glands 3 , possibly associated to many rheumatological diseases. Objectives The aim of this study was to detect, in patients affected by cryoglobulinemia vasculitis, the presence and the grade of pathological findings at level of the major salivary glands. Methods From January to December 2021, we enrolled consecutive oupatients patients affected by cryoglobulinemia (age ≥ 18 yo and a diagnosis of cryoglobulinemia vasculitis according to 2002 or 2011 classification criteria). Exclusion criteria were a previous diagnosis of other vasculitis/connective tissue diseases/inflammatory arthropathies, concomitant not rheumatological diseases or the intake of drugs possibly related to sicca syndrome symptoms. For each patient, the demographic, anthropometric and clinical history data, particularly about the cryoglobulinemia symptoms (either previous and ongoing) and past or current therapies have been collected. Furthermore, the values of erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], Rheumatoid Factor [RF] and C4 serum complement fraction have been recorded. The presence and the titre of the cryoglobulins have been recorded. For each patient, the Schirmer’s Test and the evaluation of the unstimulated whole salivary (UWS) flow were performed. The Schirmer Test was considered positive if &lt; 5 mm/min at least in one eye and the UWS flow was defined pathological if &lt; 1,5 ml/15 min. Each patient was submitted to the US examination (Esaote MyLab Twice) of both parotid and submandibular glands. Each gland was evaluated using a semiquantitative score 0-3, according to the OMERACT definitions 3 . The US score was considered pathological if ≥2. Thus, at patient level, a sum dichotomous score (normal/pathological&gt;) was provided, defining it as “pathological” if any parotid or submandibular glands scored ≥ 2. Results We enrolled 20 patients, all females, with a mean age of 68.8 years (SD± 13.32) and a mean disease duration of 11.76 (SD±8.25). For 18 patients was reported a previous HCV infection. 16/18 HCV + subjects reached the remission of the infection with undetectable HCV viremia. Among the patients enrolled, 10 referred at least one syndrome sicca symptom: 5 patients both xerostomia and xerophthalmia, 4 only xerostomia and 1 only xeropthalmia. Considering blood tests, the cryoglobulins were detected in 14, the ESR title was above the limit in 7 patients and the CRP in 3. The RF was detected in 12 subjects. The Schirmer’s test was pathological in 9 patients while the UWS flow was under the limit in 3. As regards the US reports, 2 patients had pathological features scored as≥2, while 7 patients showed minor alterations scored as 1. So, according to the sum score, only 2 patients were classified as pathological. No correlations were identified between the clinical and the US data. Conclusion In this cohort of patients with cryoglobulinemia, the US mainly showed mild pathological features at level of the parotid and submandibular structure, suggesting that syndrome sicca symptoms could be related to different pathological mechanisms in these patients, possibly strongly associated to HCV infection. Further and larger studies are necessary to confirm our preliminary data. References [1]Baer AN et al, Rheum Dis Clin North Am. 2018 [2]Sebastiani M et al, Current Drug Targets 2017 [3]La Paglia G et al, Clin Rheumatology 2019 Disclosure of Interests Antonella Adinolfi Speakers bureau: BMS, Paid instructor for: Janseen, Nicola Ughi Speakers bureau: ROCHE, PFIZER, ALFASIGMA, ABBVIE, GALAPAGOS, BRISTOL MYERS SQUIBB, Paid instructor for: JANSSEN, Davide Antonio Filippini: None declared, Michel Chevallard: None declared, Laura Belloli: None declared, Cinzia Casu: None declared, Maria Di Cicco: None declared, Clizia Gagliardi: None declared, Maria Chiara Gerardi Speakers bureau: Eli-Lilly, Marina Muscarà: None declared, Elisa Verduci: None declared, oscar massimiliano epis: None declared